Is this your first sick / fit note for this illness?
First Sick / Fit Note
How long have you been ill (including holidays and weekends)?
Are you self-isolating because you, or someone you live with, has symptoms of coronavirus?
This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records.